Take the window bed - even in the Matrix. The Ecocebo effect

 

 

We've all heard of the Placebo effect. But a recent paper by Zandonai & Chiamulera highlighted the "Ecocebo" effect, where a patient’s environment, perceived or real, has a measurable impact on drug effectiveness. This implies that clinical trials should aim for consistency in environment, but also it may open another aspect of therapy.

 

What is an Ecocebo?

It could be defined as a placebo-like effect from one's immediate environment. A variation on this is "neuroarchitecture", the cognitive and emotional response to the built environment, reviewed in Higuera-Trujillo et al, (2021).

So, some examples

A pioneering study by Roger Ulrich published in 1984 compared post-surgical outcomes between two groups with a simple difference - half had windows with natural scenery and light, the other half had windows facing brick walls. The first group not only recovered better, they took less strong medication.

Natural light does seem to be an important factor. Walch et al. (2005) found that spinal surgery patients exposed to high-intensity sunlight required 22% less pain medication per hour, and had 21% less pain medication costs, compared to those in low-light conditions.

Beyond this, in general what gives pleasure helps the patient, and what causes stress does not. But quantifying how to achieve this is not necessarily easy, although it can be done. To take a specific example, Bar and Meta (2007) found curved furniture to be preferred to furniture with sharp corners, and hypothesised this is due to a threat perception as the amygdala is preferentially stimulated by the presence of sharp edges. However, it does seem to be a general pattern, Vartanian et al (2013) showed that not only did subjects prefer curved rooms rather than rectangular rooms with corners, but the curvilinear rooms preferentially activated the anterior cingulate cortex, a region associated with the emotional perception of pain. 

 

Study of the Ecocebo effect - Virtual Reality

Obviously, it is somewhat difficult to build hospital wards specifically for such a study. However, Zandonai & Chiamulera argue that improvements in virtual reality (VR) technologies do present an alternative, being sufficiently "immersive" to fool the brain. Readers have doubtless seen how even watching a good movie can elicit different emotional responses.

Mimicking the original study, volunteers suffering chronic migraines were subjected to a laser pain stimulus when immersed in either a standard hospital waiting room, or an "ideal" room with a sea view. Those lucky enough to get the sea view reported less pain (Tommaso et al 2013).

Following on from this, Presti et al (2022) generated a VR system that presented different architectural features to volunteers, causing varying emotional responses, and this is just one example.

VR therefore would appear to have possibilities for study of beneficial medical environments, or indeed as a treatment itself.

Care should be taken with this technique though. Marín-Morales et al (2021), monitored subjects as they walked through a museum exhibit on the Holocaust, and an identical VR equivalent. Both groups self reported very similar emotional responses, but the VR group had considerably less heart rate variation and vagal stimulation. As Zandonai & Chiamulera comment, the "sense of presence" is subjective, variable, and difficult to quantify.

 

References

Bar, M., Neta, M. (2007). Visual elements of subjective preference modulate amygdala activation. Neuropsychologia, 45, 2191–2200.

Higuera-Trujillo, J. L., Llinares, C., & Macagno, E. (2021). The Cognitive-Emotional Design and Study of Architectural Space: A Scoping Review of Neuroarchitecture and Its Precursor Approaches. Sensors, 21(6), 2193. https://doi.org/10.3390/s21062193. 

Marín-Morales J, Higuera-Trujillo JL, Guixeres J, Llinares C, Alcañiz M, Valenza G. (2021). Heart rate variability analysis for the assessment of immersive emotional arousal using virtual reality: Comparing real and virtual scenarios. PLoS One, 16(7):e0254098. doi: 10.1371/journal.pone.0254098.

Presti P, Ruzzon D, Avanzini P, Caruana F, Rizzolatti G, Vecchiato G. (2022). Measuring arousal and valence generated by the dynamic experience of architectural forms in virtual environments. Sci Rep., 12(1):13376. doi: 10.1038/s41598-022-17689-9.

de Tommaso M, Ricci K, Laneve L, Savino N, Antonaci V, Livrea P. (2013). Virtual visual effect of hospital waiting room on pain modulation in healthy subjects and patients with chronic migraine. Pain Res Treat., 2013:515730. doi: 10.1155/2013/515730.

Ulrich, R.S. (1984). View Through a Window May Influence Recovery from Surgery. Science, 224, 420-424.DOI:10.1126/science.6143402.

Vartanian, O., Navarrete, G., Chatterjee, A., Fich, L.B., Leder, H., Modroño, C., Nadal, M., Rostrup, N., Skov, M. (2013). Impact of contour on aesthetic judgments and approach-avoidance decisions in architecture. Proc. Natl. Acad. Sci. USA, 110, 10446-10453.

Walch, J.M., Rabin, B.S., Day, R., Williams, J., Choi, K., Kang, J. (2005). The effect of sunlight on postoperative analgesic medication use: A prospective study of patients undergoing spinal surgery. Psychosom. Med., 67, 156-163.

Zandonai, T., & Chiamulera, C. (2025). The Interplay Between Environment and Drug Effects: Decoding the Ecocebo Phenomenon with Virtual Technologies. Sensors, 25(17), 5268. https://doi.org/10.3390/s25175268